Hello Donna
Thanks for reaching out on EnableMe and I am sorry to hear what has been happening for your Brother in Law Kenny, and for you and Andrew. Caring about someone can make these types of impacts after a stroke really challenging. As you have described, changes in behaviour, and especially disinhibited behaviour can be very difficult to manage.
Disinhibited sexual behaviour can happen because the person is not able to follow or understand usual social rules about when and where it is appropriate to say or do something. This might be caused by a lack of inhibition or a decreased awareness of appropriate and inappropriate behaviour, increased impulsivity and perhaps an inability to express his own sexual needs. The way you have described Kenny’s behaviours such as the sexual innuendo, masturbation and refusing to wear pants can be quite common for someone who has experienced a brain injury and lacks insight.
You have mentioned the Dr and Social worker had talked about strokes leading to disinhibited behaviour or a lack of insight into behaviour after a stroke. Was this when Kenny was in Hospital, or has he seen a Dr since his discharge? It might be helpful to see if Kenny would be happy to go and see his Gp, and perhaps get his consent to raise these issues with the GP, r attend the appointment with Kenny. Medications can sometimes be helpful in these situations, especially if Kenny is putting himself, or others at risk.
What you have already tried, such as talking to Kenny about his inappropriate behaviour is certainly a good place to start. It could also be helpful to continue to provide direct and immediate feedback to Kenny when his behaviour is inappropriate. Make sure you are clear and consistent with your feedback whilst still being calm and mindful of his feelings. Don’t let the behaviour happen without telling Kenny it is not appropriate. We know that after a stroke, neuroplasticity (the brains ability to regenerate damaged pathways) can improve with repetition.
It may also be helpful to see if the use of distraction may help in situations where Kenny’s behaviour becomes more disinhibited. Sometimes it can be helpful to change the conversation, use music or other things that Kenny may like to divert his focus and attention from his behaviour. You should always keep in mind your and others safety when using diversion tactics.
It is also important to make sure that you, or others in the house are safe, even though Kenny is frailer than he used to be. Make sure you always have your mobile phone on you, or carry a personal alarm, or try not to be near him when you can sense his behaviour might be becoming more disinhibited. I know this is easier said than done. But you being safe is so very important.
Getting Kenny a neuropsychology assessment would potentially also be helpful to determine exactly how the stroke has impacted on him, and work on strategies that may be able to assist Kenny to manage his behaviour. Psychology input may also be helpful if Kenny could manage talking with someone from with his cognitive changes. Psychological input through the use of something like cognitive behavioural therapy (a type of talking therapy that focuses on thinking and behaviour and how they are connected). This way they could work with him on how to better manage his behaviour and help him to better understand the impact his behaviour is having on both himself and others.
Any disinhibited or challenging behaviour, can be a distressing for the person with brain injury, and also for yourself as family. It can also, as you have realised be distressing or worrying for others who perhaps don’t have a good understanding of an acquired brain injury. It sounds like you are being sensible with limiting visitors to your home whilst Kenny is staying with you. Does he usually live alone, and have you thought about and talked with him about what will happen if he goes home?
How are you and Andrew managing, this type of stress can impact on your own relationship, in addition to both your relationship with Kenny. If you two would like to talk about it with a professional, you might like to reach out to Relationships Australia as they can help you and Andrew manage your relationship with Kenny as well.
There are also other private services in the community that can provide good information and resources about this topic, if you reach out to us via phone or email we can provide you with more information regarding these supports. The ones that might be helpful include Synapse, Australia’s Brain Injury organisation here, and the Acquired Brain Injury Outreach Services (ABIOS) located in Queensland here.
This is a really challenging situation for you all to be experiencing. We would be happy to talk with you in more detail about what is happening for Kenny and for you and Andrew. Do feel free to reach out to us and give us a call on Ph 1800 787 653, or email us on strokeline@strokefoundation.org.au. We are available Monday to Friday 9am to 5pm AEST. It would be good to talk with you in more detail.
Warm regards
Siobhan (StrokeLine)
